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Diabetes Management Evaluation of the JuniorSTAR ® Half-unit Insulin Pen in Young People with Type 1 Diabetes – User Perspectives David Klonoff, 1 Irina Nayberg, 1 Ivana Rabbone, 2 Wolfgang Landgraf, 3 Catherine Domenger 3 and Thomas Danne 4 1. Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California, US; 2. Department of Paediatrics, University of Turin, Italy; 3. Sanofi, Paris, France; 4. Auf der Bult Children and Youth Hospital, Hannover, Germany Abstract This paper discusses the results of a survey on the usability of a new half-unit insulin pen, JuniorSTAR® (CE mark pending, under the responsibility of Haselmeier), in children with type 1 diabetes. Insulin pen devices have advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use and superior accuracy, especially when delivering small doses of insulin. The accuracy and design of insulin pens is particularly important in the paediatric population. Young children often require half-unit adjustments. As the incidence of type 1 diabetes is expected to increase in the coming years in children less than 5 years old, a higher use of half-unit dosing pens may be anticipated. A survey with JuniorSTAR half-unit insulin pen has shown that it is easy to use, read, carry and dial back. This was confirmed by patients and also by nurses. In conclusion, the JuniorSTAR half-unit pen is well suited to the lifestyle of young people with type 1 diabetes and could help them to gain autonomy to self-inject. Keywords Adolescents, children, insulin pen, type 1 diabetes Disclosure: David Klonoff is a consultant for Sanofi and InsuLine. Irina Nayberg is a consultant for NovoNordisk. Ivana Rabbone has no conflicts of interest to declare. Wolfgang Landgraf and Catherine Domenger are Sanofi employees. Thomas Danne has received honoraria for speaking engagements from several companies involved in the diabetes field and has received grant support for the conduct of studies or scientific meetings from Abbott, Sanofi, Bayer, Roche, Boehringer, Bristol-Myers Squib, Lilly, Medtronic, DexCom and NovoNordisk. Acknowledgements: Editorial assistance was provided by Katrina Mountfort at Touch Medical Media. Received: 22 July 2013 Accepted: 5 August 2013 Citation: European Endocrinology, 2013;9(2):82–5 Correspondence: David Klonoff, Medical Director, Diabetes Research Institute, Mills-Peninsula Health Services, 100 South San Mateo Drive, Room 5147, San Mateo, California 94401, US. E: dklonoff@diabetestechnology.org Support: The publication of this article was funded by Sanofi. The views and opinions expressed are those of the authors and not necessarily those of Sanofi. Type 1 diabetes is the most common metabolic disorder in children. Worldwide, there are approximately 490,000 children with type 1 diabetes, and 78,000 new cases are diagnosed each year. 1 As of today, the incidence of type 1 diabetes in children younger than 15 years old is increasing. If this trend continues, new cases in European children less than 5 years are predicted to double between 2005 and 2020. 2 Type 1 diabetes is a lifelong condition with short- and long-term implications. Recommendations by the American Diabetes Association (ADA) support the use of an intensive insulin regimen that involves a ‘basal/bolus’ pattern of insulin administration to maintain blood glucose levels as close to normal as possible, with a target glycated haemoglobin (HbA1c) of 7.5 % to 8.5 % in children aged younger than 6 years, less than 8 % in children aged 6–13 years and less than 7.5 % in those aged 13–18 years. 3 The recommendation of the International Diabetes Federation (IDF) and the International Society for Paediatric and Adolescent Diabetes (ISPAD) is to reach a target of less than 7.5 % in all age groups (children and adolescent). 4 These targets can be achieved by intensive management of the condition, involving multiple insulin injections, blood glucose monitoring, nutrition planning and detection and treatment of hypoglycaemia. 5 The medical benefits of insulin regimes in type 1 diabetes are well established. 6–8 However, there is a danger that metabolic targets may be 82 attained at the expense of the psychological wellbeing of children and their families. Children and adolescents with diabetes are still developing cognitively and emotionally, therefore self-management is challenging, 9 particularly when acknowledging or adapting to the disease conflicts with their lifestyles. 5,10 In adolescence, these challenges may result in conscious behaviours (e.g. choosing not to inject at a social event) that may be mistaken for simple non-compliance. 10 With increasing age, autonomy in relation to disease management becomes important. 11 Self- management presents different challenges to younger patients: children frequently make mistakes in self-administering insulin but increasing age is associated with improved insulin administration skills. 12 There is therefore a need to make the process of insulin administration as simple and convenient as possible to avoid errors, particularly in relation to adjusting doses of insulin. Insulin pens, comprising an insulin cartridge, a dial button to set the dose and disposable needles, have facilitated insulin delivery for young people. 13 Compared with syringes, pen devices lead to better compliance, because a pen is easier to carry around, are quicker to inject, give more accurate dosing and are more cost-effective. 14 To cope with the needs of an increasingly young user base, pens have become more sophisticated with higher technology, easier to use and are able to dose in smaller increments. Half-unit dose increment insulin pens © Touch ME d ica l ME d ia 2013